Preventing Drug Use in Low Income Clinic Populations

描述（由申请人提供）：戒烟药物干预试验（Quit）将是美国第一个随机对照试验，旨在检测初级保健临床医生提供的简短干预方案的效果，以减少洛杉矶县2个安全网诊所低收入成年患者（18岁及以上）的“危险”药物使用和药物相关伤害。在这个小型试验中，我们将抽样使用兴奋剂（可卡因或安非他明）的“危险”患者，这是我们诊所患者中最常用的严重药物。在本研究中，“有危险”兴奋剂使用被定义为目前（过去90天）使用兴奋剂，以在世卫组织酒精物质涉及筛查试验（ASSIST）中自我报告的总分为4至26分来衡量。总共有8,000名患者将被筛选，以产生12个月的有效样本量，每种情况(1)干预情况或(2)涉及常规护理的对照情况，有200名符合条件的患者。在干预条件下，非常简短（少于5分钟）的临床医生建议戒烟使用兴奋剂，随后是2周和6周的药物健康教育课程，关于戒烟使用兴奋剂和警告使用其他“危险”物质，如酒精和烟草。被分配到对照组的患者将在临床医生的基线访问中接受药物使用的标准护理，随后将进行两次访问后电话健康教育会议，其持续时间与干预会议相同，但将涉及健康饮食，身体活动和安全带使用。随访评估将在随机分组后的6个月和12个月进行。戒瘾项目的框架是社会行动理论，简短的干预方案是基于NIDA的预防研究原则和5a在临床环境中帮助患者改变行为的方法（询问、建议、评估、协助、安排）的效用。如果在社区卫生中心环境中发现有效，该临床医生和电话兴奋剂使用健康教育计划可以成为健康促进活动的典范。这将扩大到所有“有风险”的物质使用，并在社区卫生中心之间共享。公共卫生相关性：拟议的研究将解决减少非法药物使用的迫切需要，特别是兴奋剂的使用，以及城市初级保健安全网诊所中低收入种族多样化患者群体中药物相关伤害的发生。一旦开始吸毒，低收入的多种族人口就有加速走向药物依赖的危险，这对公共卫生决策者和预防吸毒工作构成了特别关切。这项研究将首次对不同种族的“高危”兴奋剂使用者进行标准化的药物筛选和医生简短干预，即随意或频繁使用兴奋剂，没有生理或心理上的依赖表现，它可能有效地中断他们的依赖途径。

DESCRIPTION (provided by applicant): The Quit Using Drugs Intervention Trial (QUIT) will be the first randomized controlled trial in the U.S. that is powered to detect the effect of a primary care clinician delivered brief intervention protocol for reducing `at risk' drug use and drug-related harm among low-income adult patients (ages 18 and older) at 2 safety net clinics in Los Angeles County. For this small trial, we will sample patients with `at risk' use of stimulants (cocaine or amphetamines), the most commonly used serious drugs among patients at our clinic sites. "At risk" stimulant use is defined in this study as current use (past 90 days) of stimulants measured as a self-reported total score of 4 to 26 on the WHO Alcohol Substance Involvement Screening Test (ASSIST). A total of 8,000 patients will be approached for screening to yield a 12-month effective sample size of 200 eligible patients per condition (1) an intervention condition or (2) a control condition involving care as usual. In the intervention condition, very brief (less than 5 minutes) clinician advice regarding quitting stimulants use will be followed by two 2 and 6 week post-visit drug health education sessions on quitting stimulant use and cautioning against use of other `at risk' substance use such as alcohol and tobacco. Patients assigned to the control condition will receive standard care for drug use at the baseline visit with their clinician, which will be followed by two post-visit telephone health education sessions that will be of equal duration as the intervention sessions but will address healthy eating, physical activity, and seat belt use. Follow- up assessments will be conducted at 6 and 12 months post-randomization. The framework for the QUIT project is the Social Action Theory, and the brief intervention protocol is based on NIDA's principles on prevention research and the utility of the 5 A's approach for assisting behavioral changes among patients (Ask, Advise, Assess, Assist, Arrange) in the clinic setting. If found to be effective in the community health center setting, this clinician and telephone stimulant-use health education program could become a model for health promotion activities. that would be expanded to all `at risk' substance use and shared between community health centers. PUBLIC HEALTH RELEVANCE: The proposed study will address the critical need to reduce illegal drug use, in particular stimulant use, and the occurrence of drug-related harm in low-income racially diverse patient populations at urban primary care safety-net clinics. At risk for accelerated trajectories to drug dependence once drug use begins, low-income racially diverse populations pose particular concern for public health policy makers and drug-use prevention efforts. The study will be the first of its kind to standardize drug screening and physician brief intervention among racially diverse "at risk" stimulant users, that is casual or frequent use without the physiological or psychological manifestations of dependence, and it may effectively interrupt their pathway to dependence.